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EXAMINATION
INGUINOSCROTAL
EXAMINATION
HISTORY
EXAMINATION
INVESTIGATION
Appendix
Caecum
Right Ovary
Small bowel
Bladder
Uterus
Small bowel
Sigmoid colon
Left ovary
Small bowel
Descending
colon
Small bowel
Aorta
Spleen
Colon
Stomach
Duodenum
Tr colon
Aorta
Pancreas
Liver
Gallbladder
Duodenum
Ascending
colon
Aorta
Small bowel
ABDOMINAL EXAMINATION
COMPLAINT
• Abdominal swelling
• Abdominal pain
• Vomiting, Heart burn
• Dyspepsia
• Haematemsis
• Bleeding per rectum
• Bowel habbit changes
• Abdominal distension
• Loss of weight,Anorexia
• Easy fatigability
• Urinary complaint
• Gynacological symptoms
Purpose of examination
• General examination:
Mental state: drowsiness,loss of conc.
Posture:Leaning forward..Pancreatic
lesion
Facies: toxic,earthy in uraemia,liver
failure
Body built: Underweight,
Cachexia,well
Vital signs,Head, eyes, Mouth,
Abdominal
Examination/GENERAL
• Head and Neck
– Eyes
• Colour of sclera
• Pallor of eyelids
– Tongue
• Hydration
General Considerations
. The patient should have anempty bladder
The patient should be lying supine on the
.exam table and appropriately draped
The examination roommust be quiet to
perform adequate auscultation and
.percussion
ABDOMINAL EXAMINATION
.Starting the examination
All examinations start in the same way.
Firstly, the examinee introduces him or
herself to the patient, and checks that the
patient is comfortable and happy with the
procedure. The patient is thenpositioned
andexposed. The examiner should make
sure that there is the best light available
that is possible and that both the patient
.and the examiner are comfortable
ABDOMINAL EXAMINATION
Watch the patient's face for signs of discomfort
.during the examination
Use the appropriate terminology to locate your
:findings
vertical lines,2 transverse 2
lines(subcostal,intertubercular
plane
(Right Upper Quadrant (RUQ
(Right Lower Quadrant (RLQ
(Left Upper Quadrant (LUQ
(Left Lower Quadrant (LLQ
:Midline
Epigastric
Periumbilical
INSPECTION
• Expose abdomen from nipple to knee
• Stand back: Symmetery
Abdominal movement with
respiration
• Contour: from the foot of the patient
• Subcostal angle: 90-110
widened.. Inc. Intra abdominal pressure
Rising test: Contraction of Ant. Abd.wall
muscle
INSPECTION
• Umbilicus: site, shape, impulse on cough,
discharge,sinus
Dilated veins: Caput Medusae,IVC,SVC
Pubic hair distribution
Impulse at hernial orifices
Scars of previous operation
Back : scoliosis,Kyphosis,swelling
Scrotum: mass, skin changes
Swelling : site, Intra- or Extra- abdominal
(test),size,
shape,surface,skin
overlying,pulsation,impulse
Abdominal
Examination/Palpation
Clean hands & nails
Warm hands
Kneel down
Inform patient of your plans -Ask
about pain
Begin with light palpation
Examine the quadrants in an anti-
clockwise manner starting so that a
painful quadrant is last
Use one hand for palpation & one for
positioning
Abdominal Examination/Palpation
• Alternate Method
• This method is useful when the patient is
obese or when the examiner is small
compared to the patient.
• Stand by the patient's chest.
• "Hook" your fingers just below the costal
margin and press firmly.
• Ask the patient to take a deep breath.
• You may feel the edge of the liver press
against your fingers.
Other methods for liver
palpation
1-Bimanaual method:
liver edge can be more prominent
by
putting Lf. Hand under lower ribs
2-Dipping method : in tense ascites
Abdominal Examination/Palpation
Liver Span
Percussdownward from the chest in theright
midclavicular line until you detect the top edge
.of liver dullness ,(tidal percussion).. fifth space
Splenic Dullness
Percuss the lowest costal interspace in the
left anterior axillary line. This area is
.normally tympanitic
Ask the patient to take a deep breath and
percuss this area again. Dullness in this
.area is a sign of splenic enlargement
Other methods: Bimanual examination
Hooking method
Examination of the Kidneys
Normal kidney is not palpable
In suspecting renal mass.. Look for renal
angle fullness
Ballottement .. Bimanual examination
Place left hand on back below costal margin
and palpate with right hand
Murphy’s kidney punch.. Tender renal angle
with thumb
Again don’t be surprised if you can’t palpate
the kidney
Examination of abdominal
mass
• Site, Intra- or Extra- abdominal
• Temperature, tenderness
• Size, shape, surface, skin, edge
• Consistency, signs of inflammation
• Pulsation, mobility in 2 directions
Percussion
Percuss in all four quadrants using
.proper technique
A- Use the wrist
B- Use middle finger of Rt hand
opposite middle phalynx of oppsite
middle finger
• Rebound Tenderness
This is a test for peritoneal irritation.
Warn the patient what you are about to
do.
Press deeply on the abdomen with your
hand.
After a moment, quickly release pressure.
If it hurts more when you release, the
patient
Special Tests
• Costovertebral Tenderness
CVA tenderness is often associated
with renal disease.
Warn the patient what you are
about to do.
Have the patient sit up on the exam
table.
Use the heel of your closed fist to
strike the patient firmly over the
costovertebral angles.
Compare the left and right sides.
Special Tests
• Psoas Sign
• This is a test for appendicitis.
• Place your hand above the patient's
right knee.
• Ask the patient to flex the right hip
against resistance.
• Increased abdominal pain indicates a
positive psoas sign.
Special Tests
• Obturator Sign
• This is a test for appendicitis.
• Raise the patient's right leg with the
knee flexed.
• Rotate the leg internally at the hip.
• Increased abdominal pain indicates a
positive obturator sign.
RECTAL EXAMINATION
• THE RECTAL EXAMINATION
– Position on left side with knees drawn
right up into chest
– KY on glove
– Inspection first
– Index inserted to full length
– Comment on tenderness, prostate,
mass, blood, mucous, faeces
HERNIA
• Swelling : increase on cough & decrease in lying down.
Usually painless
• Complication: irreducibility,obstruction,strangulation
• Exam: standing up,inspection:
Inguinal hernia, femoral hernia D.D: Pubic tubercle test
site, size, surface,shape, expansile impulase on cough, scrotum,
other swelling
Palpation: Temp., tenderness, consistency, gurgling,edge
D.D scrotal from inguinoscrotal swelling, D.D between direct
&indirect inguinal hernia (Int. ring test, Ext.ring test)
Auscultation: Intestinal sounds if content is intestine
Transillumination : a hydrocele is translucent while hernia is
not
The scrotum
• C/O : Pain, swelling, infertility, discharge
urinary troubles
Inspection: Symmetry, size of testis, absent
testis, swelling , skin (ulcers, sinuses), penis
Palpation : a. Spermatic cord
matted :filariasis, nodules : T.B, cyst: encysted
hydrocele .varicocele (bag of warm)
b. Testis : loss of testicular sensation
(malignancy,Gumma), mass
c. Transillumination